Reconstruction of large defects in the gluteal region remains challenging... Because the gluteal region suffers from insufficient vascular pedi cles, finding reliable recipient vessels is challenging... A 70-year-old man suffered from recurrent myxoid liposarcoma in the left gluteal region... Multiple tumor resections and radiation therapy (60 Gy, 3x) resulted in a large soft tissue defect (20 × 8 cm)... The pedicle was then translocated through a subcutaneous tunnel for anastomosis (Fig. 1)... Microsurgical anastomosis was accomplished with ease behind the anterior superior iliac spine in the same position, and the defect was closed with the LDM flap in combination with a skin graft (Fig. 2)... Although these vessels typically have a sufficient diameter for anastomosis and are near the defect, they can be damaged by multiple surgeries and irradiation, as in the present case... Moreover, because they are very deep seated, dissection and anastomosis can be challenging... First, operative procedures are simple, as DIE vessels are anatomically stable and have sufficient diameters for anastomosis, even in the distal segment... Second, flap harvest and recipient preparation can be simultaneously performed in the lateral position, thereby reducing operative time... Although the anastomotic site and defect are separated to a certain extent, anastomosis can be performed without tension using a flap with a long pedicle, such as the LDM flap... The authors have no competing financial interests to declare in relation to the content of this article... The Article Processing Charge was paid by the authors.

Figure 2: After vascular anastomosis in the lateral position, the gluteal defect was closed with a free LDM flap in combination with a skin graft.

Mentions:
A 70-year-old man suffered from recurrent myxoid liposarcoma in the left gluteal region. Multiple tumor resections and radiation therapy (60 Gy, 3x) resulted in a large soft tissue defect (20 × 8 cm). To reconstruct the defect, a free latissimus dorsi myocutaneous (LDM) flap was elevated in the lateral position. Simultaneously, DIE vessels were isolated until they entered the rectus abdominis muscle as a vascular pedicle using a longitudinal abdominal incision. The pedicle was then translocated through a subcutaneous tunnel for anastomosis (Fig. 1). Microsurgical anastomosis was accomplished with ease behind the anterior superior iliac spine in the same position, and the defect was closed with the LDM flap in combination with a skin graft (Fig. 2). The postoperative course was uneventful, and the patient remains ulcer-free after 5 months.

Figure 2: After vascular anastomosis in the lateral position, the gluteal defect was closed with a free LDM flap in combination with a skin graft.

Mentions:
A 70-year-old man suffered from recurrent myxoid liposarcoma in the left gluteal region. Multiple tumor resections and radiation therapy (60 Gy, 3x) resulted in a large soft tissue defect (20 × 8 cm). To reconstruct the defect, a free latissimus dorsi myocutaneous (LDM) flap was elevated in the lateral position. Simultaneously, DIE vessels were isolated until they entered the rectus abdominis muscle as a vascular pedicle using a longitudinal abdominal incision. The pedicle was then translocated through a subcutaneous tunnel for anastomosis (Fig. 1). Microsurgical anastomosis was accomplished with ease behind the anterior superior iliac spine in the same position, and the defect was closed with the LDM flap in combination with a skin graft (Fig. 2). The postoperative course was uneventful, and the patient remains ulcer-free after 5 months.

Reconstruction of large defects in the gluteal region remains challenging... Because the gluteal region suffers from insufficient vascular pedi cles, finding reliable recipient vessels is challenging... A 70-year-old man suffered from recurrent myxoid liposarcoma in the left gluteal region... Multiple tumor resections and radiation therapy (60 Gy, 3x) resulted in a large soft tissue defect (20 × 8 cm)... The pedicle was then translocated through a subcutaneous tunnel for anastomosis (Fig. 1)... Microsurgical anastomosis was accomplished with ease behind the anterior superior iliac spine in the same position, and the defect was closed with the LDM flap in combination with a skin graft (Fig. 2)... Although these vessels typically have a sufficient diameter for anastomosis and are near the defect, they can be damaged by multiple surgeries and irradiation, as in the present case... Moreover, because they are very deep seated, dissection and anastomosis can be challenging... First, operative procedures are simple, as DIE vessels are anatomically stable and have sufficient diameters for anastomosis, even in the distal segment... Second, flap harvest and recipient preparation can be simultaneously performed in the lateral position, thereby reducing operative time... Although the anastomotic site and defect are separated to a certain extent, anastomosis can be performed without tension using a flap with a long pedicle, such as the LDM flap... The authors have no competing financial interests to declare in relation to the content of this article... The Article Processing Charge was paid by the authors.